ABSTRACT
Background: The biolimus-eluting stent [BES], with a biodegradable polymer, has not been previously compared with the everolimus-eluting stent [EES], as a second-generation drug-eluting stent [DES].We sought to compare the 1-year outcome between the PROMUS[TM] stent [EES type] and the BioMatrix[TM] stent [BES type]
Methods: From March 2008 to September 2011, all patients treated with the PROMUS[TM] stent or the BioMatrix[TM] stent for coronary artery stenosis at Tehran Heart Center were enrolled. The primary end points were 1-year adverse events, comprising death, myocardial infarction, target vessel revascularization, and target lesion revascularization. The secondary end point was stent thrombosis. The Cox proportional hazard model was used to assess the adjusted association between the stent type and the follow-up outcome
Results: From 949 patients [66.3% male, mean age =59.48 +/- 10.46 y] with 1,018 treated lesions, 591 patients [630 lesions, 65.1% male, mean age = 59.24 +/- 10.23 y] received the PROMUS[TM] stent and 358 patients [388 lesions, 68.2% male, mean age = 59.88 +/- 10.83 y] were treated with the BioMatrix[TM] stent. Before adjustment, the rate of the primary end points was 3.2% and 3.4% in the EES and BES, respectively [p value = 0.925, HR [EES to BES] = 1.035, 95% CI: 0.50 to 2.13]. The rate of stent thrombosis was 2% and 1.7% in the EES and BES, respectively [p value = 0.698]. After adjustment on confounder variables, there was no statistically significant difference in major adverse cardiac events between the PROMUS[TM] stent and the BioMatrix[TM] stent [p value = 0.598, HR [EES to BES] = 0.817, 95% CI: 0.39 to 1.73]
Conclusion: At 1 year's follow-up, the BES and EES showed similar safety and efficacy rates in the patients undergoing percutaneous coronary intervention with a relatively low rate of adverse events in the 2 groups
ABSTRACT
Clinical trials of revascularization have routinely under-enrolled elderly subjects. Thus, symptom relief and improved survival might not apply to elderly patients, in whom the risk of mortality and disability from revascularization procedures seems to be high and co-morbidity is more prevalent. The present case control study was performed to draw a comparison in terms of the procedural success, procedural and in-hospital complications, and major adverse cardiac events [MACE] in a one-year follow-up of octogenarians [age >/= 80 years] with a selected matched younger control group in the Tehran Heart Center Angioplasty Registry. According to the Tehran Heart Center Interventional Registry of 9, 250 patients with a minimum follow-up period of one year between April 1993 and February 2010, 157 percutaneous coronary intervention [PCI] procedures were performed in 112 octogenarians. Additionally, 336 younger patients [459 PCI procedures] were selected from the database as the propensity-score matched controls. There were 147 [93.6%] and 441 [96.1%] successful PCI procedures in the elderly group and control group, respectively [p value = 0.204]. Procedural complications were seen in 5 [3.2%] of the elderly group and 16 [3.5%] of the control group [p value = 0.858]. Totally, 7 [6.3%] in-hospital complications occurred in the elderly group and 22 [6.8%] in the control group [p value = 0.866]. One-year MACE was seen in 9 [9.1%] of the elderly and 18 [5.8%] of the control group [p value = 0.26]. Procedural success and complications, in-hospital complications, and one-year MACE were not significantly different between our two study groups. Therefore, age alone should not be used as the sole criterion when considering revascularization procedures. Furthermore, PCI should not be refused in octogenarians if indicated
ABSTRACT
Transcatheter closure of atrial septal defect secundum [ASD-II] has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography [TEE] method for measuring atrial septal defect with balloon occlusive diameter [BOD] in transcatheter ASD-II closure. A total of 39 patients [71.1% female, mean age: 35.31 +/- 15.37 years] who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography [TTE] and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1-2 mm larger than the BOD of the defect. The mean defect size obtained by TEE and BOD was 18.50 +/- 5.08 mm and 22.86 +/- 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 +/- 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD=0.773 ASD size by TEE+8.562; r2=67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values [r=-0.394, p value=0.013]. In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure
Subject(s)
Humans , Male , Female , Aged , Child , Adolescent , Adult , Middle Aged , Echocardiography, Transesophageal , DiagnosisABSTRACT
Transcatheter occlusion of the patent ductus arteriosus [PDA] is a minimally invasive treatment. The appropriate device size is chosen based on the angiographic measurement of the PDA. The current study aimed to assess the relationship between the transthoracic echocardiographic [TTE] measurements of the PDA prior to the occlusion procedure and the actual size of the deployed device. We reviewed the available records of 7 patients [2 male] who underwent the procedure at our institution [mean age: 21 +/- 12.7years, range: 7 to 46years]. PDA closure was performed successfully using the Amplatzer Duct Occluder [n = 5] and its Chinese copycat, Cardi-O-Fix Occluder [n =2]. The TTE measurement of the aortic end diameter of the PDA showed a good linear regression correlation with the size of the implanted duct occluder [duct occluder size = 0.543 + [0.941 x TTE measured diameter], R = 0.907; p value
Subject(s)
Humans , Male , Female , Echocardiography , Minimally Invasive Surgical ProceduresABSTRACT
To describeour experience of primary angioplasty in ST-segment elevation myocardial infarction. During a period of 2 years [April 2003 to May 2005], 83 high-risk patients presenting with acute ST-segment elevation myocardial infarction underwent primary angioplasty subject to availability ofballoon dilation within 90 min of admission. In total, 73 stents were implanted; 69 were bare metal stents, while the remaining 4 were paclitaxel-eluting stents. Of the 83 patients, 8 presented with cardiogenic shock. Follow-up was for a period of 9 months. All angiographic, in-hospital and clinical outcomes were recorded on a database. The procedure was successful in 79 of the 83 patients [95%] and unsuccessful in 4 [5%]. Of these 4 patients, 3 died and 1 was treated medically. In 65 patients with zero perfusion, angioplasty was successful in 61 [93.8%], while it was completely successful [100%] in the remaining 18 patients with thrombolysis in myocardial infarction grade 3 perfusion.Vessel patency was achieved in 95% with thrombolysis in myocardial infarction grade 3 flow present in 93%. A total of 7 [8.5%] patients died while in the hospital. Of the 8 with initial cardiogenic shock on presentation, 4 [50%] died in the hospital and of the remaining 4, 1 was lost at 9-month follow-up. In-hospital reocclusion and reinfarction did not occur in any patient. Theresults suggest that primary angioplasty is logistically feasible in our center with good clinical outcomes